“A Lightbulb Moment all the way through” An exploration into participant experiences of a novel Group Formulation Programme

Mental health services have shifted from a focus on clinical recovery toward a personal recovery ethos. The link between personal recovery and psychology can be seen within psychological formulation, given its emphasis on a collaborative approach and the inclusion of client voices. This thesis aimed to address two gaps within the respective literatures of personal recovery and psychological formulation. First, personal recovery frameworks have been applied to several mental health difficulties but have not yet been explored with a substance use population. Second, psychological formulation has rarely been explored from a client perspective and has not been researched as a group-based intervention.Two studies were conducted as part of this thesis. First, a systematic review of qualitative studies regarding the experiences of personal recovery for individuals with substance use difficulties was undertaken. A ‘Best Fit’ framework synthesis methodology was employed, using the a-priori ‘CHIME’ framework to organise studies in this area. The second study, an empirical qualitative study, aimed to explore participant’s understanding of their personal formulations before and after engaging with a new Group Formulation Programme, consisting of two streams (Young Adult and Dual Diagnosis). This study also sought to explore participant’s experiences of formulating their lived experiences and difficulties in the context of a transdiagnostic group setting designed to aid in understanding formulation. Reflexive Thematic Analysis (RTA) was used to analyse qualitative data. Systematic Review: 10 studies met inclusion criteria. A ‘Best-Fit’ framework synthesis indicated that the ‘CHIME’ framework captured most but not all personal recovery experiences of individuals with substance use difficulties, including the need for supportive connections, hope and belief in recovery, developing a sense of self separate to substance use, exploring meaning making in relation to addiction, and finding empowerment in control and personal responsibility. However, the original framework did not account for the significant difficulties related to trauma, loss, and stigmatisation that often accompany recovery in addiction. The addition of a ‘Difficulties’ domain specific for recovery in substance use supports the use of a CHIME-D framework, which has previously been suggested as an expansion of CHIME to encapsulate positive and challenging aspects of personal recovery. Empirical Study: 21 adults attending two streams of a novel Group
Formulation Programme took part in semi-structured interviews pre-programme, with 15 participants completing post-programme interviews. Pre-Group Formulation data produced 4 themes: 1) Challenging Life Experiences, 2) The Cyclical Nature of Coping, 3) At an Impasse, and 4) Fractured Self. Post-intervention data produced 4 themes: 1) New Understandings, 2) Repairing the Relationship with Self, 3) Peaks, Valleys, and the Road Ahead, and 4) Group Experience. Data pre-Formulation Programme highlighted the perceived impact of adverse experiences on the development of mental health difficulties, the impact of difficulties on the self and on psychosocial functioning. Results post-Formulation Programme emphasised the Conclusion. The systematic review and empirical study sought to explore the linked concepts of personal recovery and psychological formulation from the perspective of those with lived experience. Results from both highlight the impact of trauma and adverse experiences on mental health difficulties and substance use. Results from the systematic review signified the need for services to be mindful of the challenges
associated with personal recovery from a stigmatised difficulty such as addiction. Results from the empirical study indicated that participants developed a greater understanding of their experiences through formulation and that through insight-building were able to self-generate meaningful changes in their lives. Participant data strongly suggested that formulating in a novel transdiagnostic group-based programme was not only acceptable for participants, but allowed for experiences of connection, validation, and safety.